by
Gómez, Hernando; Del Rio-Pertuz, Gaspar; Priyanka, Priyanka;
Manrique-Caballero, Carlos L.; Chang, Chung-Chou H.; Wang, Shu; Liu, Qing;
Zuckerbraun, Brian S.; Murugan, Raghavan; Angus, Derek C.; Kellum, John A.
Critical Care Medicine: June 2022 -
Volume 50 - Issue 6 - p 935-944
OBJECTIVES:
Whether metformin exposure is associated with improved
outcomes in patients with type 2 diabetes mellitus and sepsis.
DESIGN:
Retrospective cohort study.
SETTING:
Patients admitted to ICUs in 16 hospitals in Pennsylvania
from October 2008 to December 2014.
PATIENTS:
Adult critical ill patients with type 2 diabetes mellitus
and sepsis.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
We conducted a retrospective cohort study to compare 90-day
mortality in diabetic patients with sepsis with and without exposure
to metformin during hospitalization. Data were obtained from the electronic
health record of a large healthcare system in Pennsylvania from October 2008 to
December 2014, on patients admitted to the ICU at any of the 16 hospitals
within the system. The primary outcome was mortality at 90 days. The absolute
and adjusted odds ratio (OR) with 95% CI were calculated in a propensity
score-matched cohort. Among 14,847 patients with type 2 diabetes mellitus
and sepsis, 682 patients (4.6%) were exposed to metformin during
hospitalization and 14,165 (95.4%) were not. Within a total of 2,691 patients
subjected to propensity score-matching at a 1:4 ratio, exposure to metformin (n =
599) was associated with decreased 90-day mortality (71/599, 11.9% vs 475/2,092,
22.7%; OR, 0.46; 95% CI, 0.35–0.60), reduced severe acute kidney injury (50% vs
57%; OR, 0.75; 95% CI, 0.62–0.90), less Major Adverse Kidney Events at 1 year
(OR, 0.27; 95% CI, 0.22–0.68), and increased renal recovery (95% vs 86%; OR,
6.43; 95% CI, 3.42–12.1).
CONCLUSIONS:
Metformin exposure during hospitalization is associated with
a decrease in 90-day mortality in patients with type 2 diabetes mellitus
and sepsis.
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